Services We Do and Do Not Provide

Disruptive Behavior Intensive Outpatient Program

What is the Intensive Outpatient Program for Disruptive Behavior?

The Disruptive Behavior (DB) Intensive Outpatient Program provides evidence-based treatment for parents and caregivers of children who struggle with unsafe behaviors, including aggression and property destruction. Our program lasts 6 weeks and offers therapy 3 hours per day, 3 times a week to help parents and caregivers build skills to prevent and respond to behavioral escalations in the family through the following:

  • Parent skills group meetings focused on de-escalation and behavior management strategies
  • Parent-child sessions focused on practicing plans and strategies
  • Parent wellness group meetings with parent partners who have experienced living with a child in crisis
  • Case management sessions to help parents and families connect to community resources
  • Psychiatric medicine consultations and school consultations as needed

Who can this program help?

Our DB Intensive Outpatient Program is only intended for parents and caregivers covered by Apple Health (Medicaid) at this time who have a child between the ages of 5 and 12 years old who either:

  • Is in a persistent state of externalizing behavioral crises such as aggression to self or others, property destruction, leaving the house without permission when they are aware they’re not supposed to and verbal threats to harm self or others
  • Has been in an inpatient psychiatric unit and needs treatment more intensive than routine outpatient and/or is at risk of being hospitalized again
  • Presents with severe symptoms that place them at risk for an inpatient psychiatric hospitalization or psychiatric residential treatment
  • Who has been in outpatient services that have not been successful in resolving unsafe behaviors

What’s special about the Seattle Children’s DB Intensive Outpatient Program?

Our DB Intensive Outpatient Program team will work closely with you and your family using this approach: 

  • The DB Intensive Outpatient Program is based in parent behavior management training (PBMT). Research shows that PBMT is very helpful in improving child behavior and improving family functioning.

  • The DB Intensive Outpatient Program delivers care through a team approach as opposed to individualized care. Our Intensive Outpatient Program team works closely with your family to include you in every step of the process and provide a supportive environment. 

  • The DB Intensive Outpatient Program team not only includes professionals who are experienced in working with children and youth with DB but also includes parent partners. Our parent partners have experience living with a child in crisis and are available to support your family throughout the duration of the DB Intensive Outpatient Program. 

Who is on the team?

Providers in this program include: 

You may also work with a psychiatric nurse practitioner and psychiatry or psychology trainees.

How to Get Services

We only accept referrals from the following Seattle Children’s Hospital service lines: Psychiatry and Behavioral Medicine Unit, Emergency Department and Acute Behavioral Crisis Clinic.

  • Your referring case manager will need to complete a screening form with you to determine your family’s eligibility.
  • If eligible, the case manager will provide the family with the DB Intensive Outpatient Program flyer and submit a referral with the completed screening form to the DB Intensive Outpatient Program case manager.
  • Once the referral is received, the DB Intensive Outpatient Program case manager will reach out directly to you for an initial 10-minute phone screening and schedule a 60-minute intake session.
  • After the intake session, if you and DB Intensive Outpatient Program team agree that the program will be a good fit, the DB Intensive Outpatient Program case manager will begin enrollment.

We are not accepting referrals outside of Seattle Children’s at this time.

What to Expect

We’ve made a lot of changes to our facilities to protect our patients, families and staff from COVID-19. At this time, all services will be delivered using telemedicine.

    • Plan ahead to ensure that you can attend sessions with a distraction-free environment. You should not be driving a car, riding a bike or cooking during sessions.
    • Plan for childcare or an activity for your child during the sessions. It is important to note that your child will only be involved for limited parent-child sessions. Your child will not be involved in any of the parent wellness or parent skills groups.
    • You will need to connect to sessions with both audio and video and have your camera turned on during the entire session. Please ensure that your audio and video are both working. If you have any questions about telemedicine, contact the DB Intensive Outpatient Program case manager or check out Telemedicine at Seattle Children’s.
    • You are not required to bring anything to the sessions. If you would like to take notes, we recommend having a pen and paper with you.
    • Treatment is offered through telemedicine/video visit platforms.
    • The program is intense and requires a great deal of dedication of parent and/or caregiver time. It runs 3 hours per day, 3 days per week, and lasts 6 week
    • Times will be:
      • Monday 9 a.m. to noon
      • Wednesday 2 to 5 p.m.
      • Thursday 9 a.m. to noon
    • Additionally, case management and parent partner support will be provided as needed during the program.
    • Initial Phone Screening
      • Time: One 10-minute appointment
      • What: The initial phone screening occurs when the DB Intensive Outpatient Program case manager contacts the primary caregiver directly after receiving the referral from one of the approved Seattle Children’s service lines. The DB Intensive Outpatient Program case manager will ask any follow-up questions needed to determine if the DB Intensive Outpatient Program will be a good fit for the family and schedule the intake session.  
    • Intake Session
      • Time: One 60-minute appointment
      • What: During the intake session, the primary caregiver will meet with the DB Intensive Outpatient Program case manager and clinician to assess whether the child meets medical necessity for the program and if the family is able to commit to the program. Additionally, the clinician will provide an in-depth overview of the program, program requirements and answer any questions that the caregiver may have.
    • Parent Wellness Groups
      • Time: Two 60-minute sessions a week
      • What: During the parent wellness groups, parent peer partners will collaborate and provide support in a nonjudgmental space, giving caregivers an opportunity to share their struggles and successes with other caregivers.
    • Parent Skills Group
      • Time: Three 90-minute sessions a week
      • What: During the parent skills groups, the clinicians will provide in-depth instruction on de-escalation and behavior management strategies for caregivers.
    • Parent-Child Sessions
      • Time: One 90-minute session a week
      • What: During the parent-child sessions, the clinicians will support the caregivers in smaller groups. Your child will be involved for approximately 15 minutes of the session. The goal is to practice the strategies learned during the parent skills groups.
    • The DB Intensive Outpatient Program requires that the primary caregiver be present for every appointment. Additionally, we welcome and encourage other caregivers and family support to attend the appointments if they are available.
    • During the program, we will help you find your next treatment team. We are unable to provide long-term follow-up treatment for families after the program ends.
    • Each activity has planned content that is important to learn. If you miss more than 3 sessions or visits, you will be politely removed from the remainder of the program.
    • If you need to cancel or plan to miss a session, please email the DB Intensive Outpatient Program case manager as soon as possible.
    • Due to the structure of our program, we are unable to reschedule appointments for a later date.
    • If you are more than 15 minutes late for more than 3 sessions, the DB Intensive Outpatient Program team will meet with you to discuss if the program remains a good fit for your family.
    • Any no-shows will be counted towards the 3 missed visits allowed for each family. If you miss or no-show more than 3 sessions or visits, you will be politely removed from the remainder of the program.

Contact Us

We are not accepting referrals outside of Seattle Children’s at this time.

If you have not been enrolled in the DB Intensive Outpatient Program and have questions, please contact your Seattle Children’s referring case manager.

If you are enrolled in the DB Intensive Outpatient Program and have questions, please contact your DB Intensive Outpatient Program case manager.

Paying for Care

This program is only available for families covered by Apple Health (Medicaid) at this time through pilot project funding from Washington State Health Care Authority. There is no cost to eligible families.

In a Crisis?

If your child or family needs help right away, call your mental health crisis line or text HOME to 741741.

If you or a family member has a problem with a substance use disorder, please consider calling SAMHSA’s National Helpline, 800-662-4357.